Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Yu , YUN Xing ^△ , LIU Yang ,  WEI Min

Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China;

Corresponding?author：

WEI Min, Email: weim301gk@sina.com

Keywords：

Anterior cruciate ligament; wide awake local anesthesia no tourniquet technique; arthroscopy; suture repair; effectiveness

DOI：

10.7507/1002-1892.202008127

Video：

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Objective To investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique.Methods Between July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction.Results The operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant (P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension.Conclusion Using WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient’s own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.

Citation： WEI Yu, YUN Xing, LIU Yang, WEI Min. Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 337-342. doi: 10.7507/1002-1892.202008127 Copy

1.	Samuelsen BT, Webster KE, Johnson NR, et al. Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47, 613 patients. Clin Orthop Relat Res, 2017, 475(10): 2459-2468.
2.	Proffen BL, Sieker JT, Murray MM. Bio-enhanced repair of the anterior cruciate ligament. Arthroscopy, 2015, 31(5): 990-997.
3.	Liao W, Zhang Q. Is primary arthroscopic repair using the pulley technique an effective treatment for partial proximal ACL tears? Clin Orthop Relat Res, 2020, 478(5): 1031-1045.
4.	Gobbi A, Whyte GP. Long-term outcomes of primary repair of the anterior cruciate ligament combined with biologic healing augmentation to treat incomplete tears. Am J Sports Med, 2018, 46(14): 3368-3377.
5.	Andersen RB, Gormsen J. Fibrin dissolution in synovial fluid. Scand J Rheumatol, 1987, 16(1): 319-333.
6.	An M, Su X, Wei M, et al. Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study. J Orthop Surg (Hong Kong). 2020, 28(2). doi: 10.1177/2309499020938122.
7.	李冀, 李眾利, 張浩, 等. 局部麻醉下關節鏡手術摘除腘窩囊腫并膝關節腔清理的臨床療效觀察. 中國骨傷, 2017, 30(10): 920-925.
8.	van der List JP, Mintz DN, DiFelice GS. The location of anterior cruciate ligament tears: A prevalence study using magnetic resonance imaging. Orthop J Sports Med, 2017, 5(6): 2325967117709966.
9.	El-Hakeim EH, Elawamy A, Kamel EZ, et al. Fluoroscopic guided radiofrequency of genicular nerves for pain alleviation in chronic knee osteoarthritis: A single-blind randomized controlled trial. Pain Physician, 2018, 21(2): 169-177.
10.	van der List JP, DiFelice GS. Arthroscopic primary anterior cruciate ligament repair with suture augmentation. Arthrosc Tech, 2017, 6(5): e1529-e1534.
11.	Fayard JM, Sonnery-Cottet B, Vrgoc G, et al. Incidence and risk factors for a partial anterior cruciate ligament tear progressing to a complete tear after nonoperative treatment in patients younger than 30 years. Orthop J Sports Med, 2019, 7(7). doi: 10.1177/2325967119856624.
12.	Adachi N, Ochi M, Uchio Y, et al. Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense. Acta Orthop Scand, 2002, 73(3): 330-334.
13.	Seijas R, Ares O, Cuscó X, et al. Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors. World J Orthop, 2014, 5(3): 373-378.
14.	Diermeier T, Rothrauff BB, Engebretsen L, et al. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2390-2402.
15.	楊渝平, 敖英芳, 劉曉鵬, 等. 急性前交叉韌帶實質部完全斷裂的發生部位及有關因素研究. 中國微創外科雜志, 2011, 16(9): 837-840.
16.	孟小光, 史福東, 王雪臣, 等. 前交叉韌帶斷裂發生部位及其影響因素的多元Logistic回歸分析. 中國醫藥導報, 2016, 13(3): 87-89.
17.	Temponi EF, de Carvalho Júnior LH, Sonnery-Cottet B, et al. Partial tearing of the anterior cruciate ligament: diagnosis and treatment. Rev Bras Ortop, 2015, 50(1): 9-15.
18.	Wasserstein D, Khoshbin A, Dwyer T, et al. Risk factors for recurrent anterior cruciate ligament reconstruction: a population study in Ontario, Canada, with 5-year follow-up. Am J Sports Med, 2013, 41(9): 2099-2107.
19.	Colombet P, Dejour D, Panisset JC, et al. Current concept of partial anterior cruciate ligament ruptures. Orthop Traumatol Surg Res, 2010, 96(8 Suppl): S109-S118.
20.	Dejour D, Ntagiopoulos PG, Saggin PR, et al. The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears. Arthroscopy, 2013, 29(3): 491-499.
21.	Haviv B, Kittani M, Yaari L, et al. The detached stump of the torn anterior cruciate ligament adheres to the femoral notch wall and then to the posterior cruciate ligament within 6 months from injury. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2653-2658.
22.	Brophy RH, Tycksen ED, Sandell LJ, et al. Changes in transcriptome-wide gene expression of anterior cruciate ligament tears based on time from injury. Am J Sports Med, 2016, 44(8): 2064-2075.
23.	Novaretti JV, Astur DC, Casadio D, et al. Higher gene expression of healing factors in anterior cruciate ligament remnant in acute anterior cruciate ligament tear. Am J Sports Med, 2018, 46(7): 1583-1591.
24.	Zhang S, Matsumoto T, Uefuji A, et al. Anterior cruciate ligament remnant tissue harvested within 3-months after injury predicts higher healing potential. BMC Musculoskelet Disord, 2015, 16: 390.
25.	Eriksson E, H?ggmark T, Saartok T, et al. Knee arthroscopy with local anesthesia in ambulatory patients. Methods, results and patient compliance. Orthopedics, 1986, 9(2): 186-188.
26.	王江濤, 劉玉杰, 王俊良, 等. 局麻關節鏡下 Fast-fix 縫合半月板損傷的臨床療效. 中國骨傷, 2014, 27(8): 683-685.
27.	魏民, 王志剛, 劉玉杰, 等. 氟比洛芬酯與氯諾昔康對局麻膝關節鏡術超前鎮痛的效果比較. 中國藥房, 2013, 24(2): 155-157.
28.	魏民, 朱娟麗, 劉洋. 關節鏡下前交叉韌帶袖套狀保殘重建的臨床效果. 中國骨傷, 2017, 30(1): 25-28.
29.	DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy, 2015, 31(11): 2162-2171.
30.	Shelbourne KD, Benner RW, Gray T. Results of anterior cruciate ligament reconstruction with patellar tendon autografts: objective factors associated with the development of osteoarthritis at 20 to 33 years after surgery. Am J Sports Med, 2017, 45(12): 2730-2738.

1. Samuelsen BT, Webster KE, Johnson NR, et al. Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47, 613 patients. Clin Orthop Relat Res, 2017, 475(10): 2459-2468.
2. Proffen BL, Sieker JT, Murray MM. Bio-enhanced repair of the anterior cruciate ligament. Arthroscopy, 2015, 31(5): 990-997.
3. Liao W, Zhang Q. Is primary arthroscopic repair using the pulley technique an effective treatment for partial proximal ACL tears? Clin Orthop Relat Res, 2020, 478(5): 1031-1045.
4. Gobbi A, Whyte GP. Long-term outcomes of primary repair of the anterior cruciate ligament combined with biologic healing augmentation to treat incomplete tears. Am J Sports Med, 2018, 46(14): 3368-3377.
5. Andersen RB, Gormsen J. Fibrin dissolution in synovial fluid. Scand J Rheumatol, 1987, 16(1): 319-333.
6. An M, Su X, Wei M, et al. Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study. J Orthop Surg (Hong Kong). 2020, 28(2). doi: 10.1177/2309499020938122.
7. 李冀, 李眾利, 張浩, 等. 局部麻醉下關節鏡手術摘除腘窩囊腫并膝關節腔清理的臨床療效觀察. 中國骨傷, 2017, 30(10): 920-925.
8. van der List JP, Mintz DN, DiFelice GS. The location of anterior cruciate ligament tears: A prevalence study using magnetic resonance imaging. Orthop J Sports Med, 2017, 5(6): 2325967117709966.
9. El-Hakeim EH, Elawamy A, Kamel EZ, et al. Fluoroscopic guided radiofrequency of genicular nerves for pain alleviation in chronic knee osteoarthritis: A single-blind randomized controlled trial. Pain Physician, 2018, 21(2): 169-177.
10. van der List JP, DiFelice GS. Arthroscopic primary anterior cruciate ligament repair with suture augmentation. Arthrosc Tech, 2017, 6(5): e1529-e1534.
11. Fayard JM, Sonnery-Cottet B, Vrgoc G, et al. Incidence and risk factors for a partial anterior cruciate ligament tear progressing to a complete tear after nonoperative treatment in patients younger than 30 years. Orthop J Sports Med, 2019, 7(7). doi: 10.1177/2325967119856624.
12. Adachi N, Ochi M, Uchio Y, et al. Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense. Acta Orthop Scand, 2002, 73(3): 330-334.
13. Seijas R, Ares O, Cuscó X, et al. Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors. World J Orthop, 2014, 5(3): 373-378.
14. Diermeier T, Rothrauff BB, Engebretsen L, et al. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2390-2402.
15. 楊渝平, 敖英芳, 劉曉鵬, 等. 急性前交叉韌帶實質部完全斷裂的發生部位及有關因素研究. 中國微創外科雜志, 2011, 16(9): 837-840.
16. 孟小光, 史福東, 王雪臣, 等. 前交叉韌帶斷裂發生部位及其影響因素的多元Logistic回歸分析. 中國醫藥導報, 2016, 13(3): 87-89.
17. Temponi EF, de Carvalho Júnior LH, Sonnery-Cottet B, et al. Partial tearing of the anterior cruciate ligament: diagnosis and treatment. Rev Bras Ortop, 2015, 50(1): 9-15.
18. Wasserstein D, Khoshbin A, Dwyer T, et al. Risk factors for recurrent anterior cruciate ligament reconstruction: a population study in Ontario, Canada, with 5-year follow-up. Am J Sports Med, 2013, 41(9): 2099-2107.
19. Colombet P, Dejour D, Panisset JC, et al. Current concept of partial anterior cruciate ligament ruptures. Orthop Traumatol Surg Res, 2010, 96(8 Suppl): S109-S118.
20. Dejour D, Ntagiopoulos PG, Saggin PR, et al. The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears. Arthroscopy, 2013, 29(3): 491-499.
21. Haviv B, Kittani M, Yaari L, et al. The detached stump of the torn anterior cruciate ligament adheres to the femoral notch wall and then to the posterior cruciate ligament within 6 months from injury. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2653-2658.
22. Brophy RH, Tycksen ED, Sandell LJ, et al. Changes in transcriptome-wide gene expression of anterior cruciate ligament tears based on time from injury. Am J Sports Med, 2016, 44(8): 2064-2075.
23. Novaretti JV, Astur DC, Casadio D, et al. Higher gene expression of healing factors in anterior cruciate ligament remnant in acute anterior cruciate ligament tear. Am J Sports Med, 2018, 46(7): 1583-1591.
24. Zhang S, Matsumoto T, Uefuji A, et al. Anterior cruciate ligament remnant tissue harvested within 3-months after injury predicts higher healing potential. BMC Musculoskelet Disord, 2015, 16: 390.
25. Eriksson E, H?ggmark T, Saartok T, et al. Knee arthroscopy with local anesthesia in ambulatory patients. Methods, results and patient compliance. Orthopedics, 1986, 9(2): 186-188.
26. 王江濤, 劉玉杰, 王俊良, 等. 局麻關節鏡下 Fast-fix 縫合半月板損傷的臨床療效. 中國骨傷, 2014, 27(8): 683-685.
27. 魏民, 王志剛, 劉玉杰, 等. 氟比洛芬酯與氯諾昔康對局麻膝關節鏡術超前鎮痛的效果比較. 中國藥房, 2013, 24(2): 155-157.
28. 魏民, 朱娟麗, 劉洋. 關節鏡下前交叉韌帶袖套狀保殘重建的臨床效果. 中國骨傷, 2017, 30(1): 25-28.
29. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy, 2015, 31(11): 2162-2171.
30. Shelbourne KD, Benner RW, Gray T. Results of anterior cruciate ligament reconstruction with patellar tendon autografts: objective factors associated with the development of osteoarthritis at 20 to 33 years after surgery. Am J Sports Med, 2017, 45(12): 2730-2738.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique

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